You Don't Notice You're Exhausted Until You Can't Get Off the Couch
Someone asks how you're feeling and you genuinely don't know. Not evasive — genuinely blank. You don't notice you're exhausted until you physically can't get off the couch. You don't notice you're hungry until your hands are shaking. Your body has one volume setting left, and it's an emergency.
The Word Ikemi Gave the Silence
In 1979, Japanese psychiatrist Yujiro Ikemi published research in Psychotherapy and Psychosomatics describing patients who arrived at his practice not with vague complaints but with full physiological collapse — patients who hadn't felt the tension, the fatigue, the pain building for weeks or months, because they'd stopped registering their own bodily signals at all until the body forced the issue by breaking down. Ikemi named the pattern alexisomia, building the term the same way "alexithymia" was built a few years earlier: a- (without), lexis (words), and here, soma (body) rather than thymos (emotion). Where alexithymia describes an inability to identify and name emotions, alexisomia describes its physical sibling — an inability to perceive and interpret the body's own sensations before they escalate into crisis.
The distinction matters clinically because these two patterns often travel together but aren't identical. Someone can have a reasonably rich emotional vocabulary and still have almost no functioning early-warning system for their own physical state — no felt sense of "I am getting tense" before the tension becomes a locked jaw, no felt sense of "I am depleted" before depletion becomes an inability to stand up. The body has been sending signals the whole time. The receiver just isn't tuned to the frequency anymore.
How the Signal Gets Turned Off
Nobody is born unable to feel their own exhaustion. Ikemi's clinical population, and the case patterns built on his work since, point to a specific developmental mechanism: repeated instruction, explicit or absorbed, to override the body's early signals rather than respond to them. Push through the headache. Work through the exhaustion. Sit still and be quiet when your stomach hurts because we're not leaving yet. None of these instructions, delivered once, would do lasting damage. Delivered as a chronic pattern — years of the body's early, mild signals being consistently ignored, punished, or simply never responded to — the nervous system appears to adapt in the most economical way available to it: it stops sending the early signal at all, since the early signal was never acted on anyway. Why maintain a warning system nobody's listening to.
This is the same mechanism, seen from a different angle, that shows up in somatization research going back to Pierre Janet — the body finding a way to make itself heard when the direct channel has been shut down. Alexisomia is close to the mirror image: instead of the body escalating into symptoms to force attention, the person has lost the capacity to notice symptoms at the stage where noticing them could still prevent escalation. Both patterns end in the same place — the body only gets through in a crisis — they just arrive there from opposite directions.
The Cost of a Body Nobody's Listening To
The pattern is quietly brutal in its own specific way, distinct from ordinary stress. It isn't that the exhaustion, hunger, or tension aren't happening — the physiological reality is identical to anyone else's. It's that the early, cheap, manageable version of the signal never reaches conscious awareness, so the only version that does reach awareness is the expensive one: the panic attack instead of the rising anxiety that preceded it by hours, the total shutdown instead of the tiredness that preceded it by days, the chest pain instead of the tension that had been building, silently, for weeks. A person living this way isn't more fragile than anyone else. They're operating with a warning system that's been quietly disconnected, so every problem that would have been minor if caught early arrives instead as an emergency, because emergency is the only volume the system still transmits at.
This also explains a specific kind of self-blame that shows up in people living with alexisomia: the sense that they're being dramatic, or weak, or making a bigger deal of things than other people would. It's the opposite. By the time the signal is strong enough to register, it genuinely is a bigger deal — not because the person is fragile, but because everything that would have made it a smaller deal, caught earlier, was invisible to them by the time it mattered.
Rebuilding a Signal That Went Quiet
Ikemi's clinical framework, and the somatic practice that's built on it since, points toward one specific, unglamorous intervention: deliberately checking in with the body before it demands attention, not after. Three times a day, stop and name one physical sensation with no other goal than naming it — tight shoulders, a heavy chest, a clenched jaw, nothing more elaborate than that. It will feel pointless at first, because a system that's been shut down for years doesn't come back online with urgency or relief. It comes back as a flicker, easy to dismiss, easy to skip. That flicker is the signal being rebuilt, one deliberate check-in at a time, and the alternative — waiting for the body to force the issue again — is the same expensive pattern repeating on a loop with no scheduled end.
You are not dramatic, and you are not broken. The switch that got flipped off, usually years before you had any say in it, can be flipped back on. It just won't announce itself the way the emergencies did. It'll come back quiet, the way it was supposed to be heard in the first place.